Bromism

Bromism is the syndrome that results from the long-term consumption of bromine, usually through bromine-based sedatives such as potassium bromide and lithium bromide. Bromism was once a very common disorder, being responsible for 5 to 10% of psychiatric hospital admissions, but is now uncommon since bromide was withdrawn from clinical use in many countries and severely restricted in others.

Bromism is caused by a neurotoxic effect on the brain. The symptoms of bromism include mental dullness, memory loss, slurred speech, tremors, ataxia, and muscular weakness, a transitory state resembling paranoid schizophrenia, and a skin eruption called bromoderma. Eventually leading to somnolence, psychosis, seizures, and delirium.

High levels of bromide chronically impair the membrane of neurons, which progressively impairs neuronal transmission, leading to toxicity. Doses as small as 0.5 gram per day of bromide can lead to bromism.

While significant and sometimes serious disturbances occur to neurologic, psychiatric, dermatological, and gastrointestinal functions, death is rare from bromism.

Bromism has also been caused by excessive consumption of soda that contains Brominated Vegetable Oil, leading to headache, fatigue, ataxia, memory loss, and potentially inability to walk as observed in one case.

Brominated Vegetable Oil (or BVO) is a vegetable oil that is modified with bromine. As was (until recently) authorized, it was used in small amounts, not to exceed 15 parts per million, as a stabilizer for fruit flavouring in beverages to keep the citrus flavouring from floating to the top. Over time, many beverage makers have reformulated their products to replace BVO with an alternative ingredient. Today, few beverages in the U.S. contain BVO.

Brominated Vegetable Oils were already banned in Europe, but the American Food and Drugs Administration (finally) decided on July 3, 2024 to revoke its use as a food additive[1]. Sun Drop, manufactured by Keurig Dr Pepper, is the largest national brand in the US to still include the additive.

There is no specific treatment available for bromism. Increased intake of regular salt and water, which increases the flow of the related chloride ion through the body, is one way of flushing out the bromide.

You might think that you're now safe from bromine poisoning, but that's not entirely true: bromides can still be obtained as unregulated dietary supplements[2].

[1] FDA: Brominated Vegetable Oil (BVO). See here.
[2] Friedman, Cantrell: Mind the gap: Bromism secondary to internet-purchased supplements in American Journal of Emergency Medicine - 2022.